For the most part, gone are the days when solo practitioners put patient notes on paper, rounded on their patients in the hospital, dropped in to the physician lounge, and received the unmitigated respect and adulation of the community. While, there are still some specialties like dermatology and cosmetic surgery and direct primary care models that operate independently and have more freedom, the majority of physicians are part of a team, network or system to try to integrate care with one another. And as much as I admire and encourage those remain independent, I sometimes I wonder if we do physicians a disservice by idolizing the solo practice and paper chart "golden days" as a standard that health care should return to.

This is a question I think about a lot: how does ACMS best support and equip our members to thrive and grow in volatile, uncertain, complex and ambiguous times? I'm reading a book on organizational leadership which centers on the example of Lewis and Clark. Our heroic explorers climb to the source of the Missouri River thinking the West side of their trek to the Pacific Ocean would be the discovery of a cross-continental waterway sloping gently down to the ocean. What they see terrifies them: a range of the "most terrible mountains ever beheld," as wide and deep as the eye can see. Lewis and Clark suddenly realize canoes aren't going to cut it anymore.

Perhaps it is time in medicine to prepare ourselves for the days ahead rather than pining away for the past. This kind of leadership – corporate, team and individual leadership – is going to require a different skill set than most ever learned in residency or medical school. There may be some who decide to settle at the edge of the frontier out of exhaustion or stubbornness, a toe in the new world but close enough to the past to retreat to it. But those who decide to move ahead into the future will have to grieve that the skills that got them there won't take them much further – and then journey on.

There are a few different ways of dealing with industry change, each with increasing effort and labor required.

1) Ignore it and pretend it will go away - or just retire early.2) Whine about it because you can't ignore it.3) Look inward to see how you can reframe your attitude and response to it.4) Pro-actively shape the future of healthcare for yourself and community by leaning into it.

Lewis and Clark could have turned tail and reported back to President Jefferson that in fact there was no water route and they would have been right. But their spirit of duty, adventure, tenacity, and vision foresaw that eventually Americans would be streaming this way towards Idaho and their trek could help create the map.

Health care will always be moving us past our comfort zones and as a medical society, we must provide help to our members to learn new skill sets and sharpen the ones they have. As IMA's past-president Dr. Bruce Belzer said last summer, "The future of medicine is uncertain, but I bet that's what they said about 125 years ago." I hope to be on your team of people to help you get there.